CT和MRI诊断肝脏原发性透明细胞癌

目的 探讨原发性肝脏透明细胞癌（PCCCL）的CT和MRI特征。方法 回顾性分析12例经手术病理证实的PCCCL的CT及MRI资料,其中10例接受CT、8例接受MR及DWI。结果 12例PCCCL共14个病灶,呈结节状或类圆形,瘤径1.6~9.8 cm,平均3.6 cm。10例CT平扫呈低密度;增强后动脉期8例肿瘤呈轻度强化,门静脉期持续强化,2例动脉期不均匀明显强化,门静脉期强化程度明显下降;延迟期所有病灶均为低密度,2例显示包膜延迟强化。平扫T2WI 6例呈混杂高信号,1例呈稍高信号,1例为稍低信号;4例T1WI正相位呈稍低信号,2例呈稍高信号,2例呈等信号,反相位8例病灶信号均减低,4例减低明显。DWI 6例呈不均匀高信号,2例呈等信号。增强扫描动脉期4例肿瘤不均匀明显强化,2例轻度强化,2例呈环形明显强化;门静脉期4例强化较动脉期减低,2例轻度持续强化,2例中心填充强化;延迟期7例病灶呈相对低信号,1例呈等信号,4例显示环形强化包膜。结论 PCCCL的CT及MRI表现具有一定特征;CT和MRI是诊断PCCCL的有效方法。     

单发婴儿型肝脏血管内皮细胞瘤的CT与MRI表现

目的 分析单发婴儿型肝脏血管内皮细胞瘤(IHE)的CT与MRI表现。方法 回顾性分析12例单发IHE,其中3例同时接受CT、MR平扫及增强扫描,5例仅接受CT平扫及增强扫描,4例仅接受MR平扫及增强检查。结果 12例单发IHE中,9例病灶在肝右叶,2例在肝左叶,1例累及肝脏右前叶及左内叶;CT平扫8例病灶均呈低密度,边界清晰,其中4例病灶内可见钙化;增强扫描5例病灶动脉期明显环形强化,3例边缘结节条索样强化;2例病灶由肝动脉供血,增强各期强化程度逐渐下降,以向心性强化为主。MR平扫7例中,6例病灶T1WI呈低信号,1例低信号内混杂高信号,T2WI均为高信号内斑片条索样低信号,T2抑脂明显高信号;增强后均以环形向心性强化为主。结论 单发IHE的特征性CT、MRI表现有助于提高诊断准确率。     

肝脏上皮样血管平滑肌脂肪瘤CT和MRI表现

目的 探讨肝脏上皮样血管平滑肌脂肪瘤(EAML)的CT、MRI表现。方法 对15例经病理证实的肝脏EAML患者的CT(n=10)、CTA(n=2)、MRI(n=7)、MRA(n=1)资料进行回顾性分析,并与手术病理结果对照分析。结果 肝内单发病灶14例,多发1例。10例CT检查平扫均呈低密度。7例MR平扫T1WI呈低信号,T2WI呈高信号;1例病灶内T1WI、T2WI呈高信号,脂肪抑制为低信号,3例反相位T1WI肿瘤内信号较同相位降低;T2WI呈环形高信号假包膜4例。CT、MRI表现为"中心明显强化血管征"的患者为7、3例,表现为"快进慢出"、"延迟强化"、"快进快出"的患者数分别为6、2、2例,1、6、0例。2例CTA、1例MRA均表现为动脉供血、肝静脉或肝静脉分支引流入下腔静脉。结论 肝脏EAML影像学表现具有一定的特征性,了解其特征性的表现有助于提示诊断。     

CT和MR诊断腮腺基底细胞腺瘤

目的 探讨CT及MR诊断腮腺基底细胞腺瘤（BCA）的价值。方法 回顾性分析11例经手术病理证实的腮腺BCA患者的CT及MRI表现,并与同期经手术病理证实的52例腮腺多形性腺瘤及36例腮腺淋巴乳头状囊腺瘤进行比较。结果 11例腮腺BCA病灶均为单发,呈类圆形或椭圆形,平均最大径（22.36±8.79） mm,多位于浅叶（8/11）。6例接受CT检查,平扫5例病灶密度不均,1例密度均匀;增强扫描病灶均明显强化,边缘强化较明显,1例可见强化壁结节。5例接受MR检查,11例病灶T1WI均呈均匀低或稍低信号,T2WI呈低信号,均可见低信号包膜;增强扫描病灶均明显强化,并以边缘环形强化为主,其中1例可见明显强化壁结节。CT或MRI见血管贴边征象10例,静脉回流进同侧下颌后静脉或颈外静脉者7例。结论 腮腺BCA的CT和MRI表现具有一定特征性,有助于诊断及鉴别诊断。     

卵巢纤维瘤的CT和MRI影像特征

目的 探讨卵巢纤维瘤的CT及MRI特征。方法 回顾性分析经手术病理证实的42例卵巢纤维瘤的CT及MRI资料,21例患者接受CT检查,26例接受MR检查,5例同时接受CT和MR检查,分析其CT和MR特征。结果 42例卵巢纤维瘤中单纯型29例,变性型11例,特殊型2例。肿瘤均单发,呈圆形、类圆形或分叶状,边界清晰40例,部分边界模糊2例,伴钙化3例,出血1例。肿瘤最大径1.4~26.7 cm,中位值5.5 cm。单纯型CT平扫呈等密度,MRI上T1WI及T2WI均呈低信号;变性型CT呈斑片状、裂隙状低密度区,T2WI呈高信号,增强扫描肿瘤实质几乎无强化或仅轻微强化;特殊型1例内见大量出血,1例明显强化,均误诊为恶性肿瘤。结论 卵巢纤维瘤的CT及MRI表现具有一定的特征,但确诊仍需依靠病理。     

上皮样血管内皮瘤MRI表现

目的 观察上皮样血管内皮瘤（EHE） MRI表现。方法 回顾性分析经病理证实的23例EHE患者,均接受病灶部位MR平扫,其中21例接受增强MR扫描,观察其MRI表现。结果 23例中,骨EHE 8例,肝脏EHE 8例,皮肤或肌肉软组织EHE 3例,颅内EHE 2例,鼻腔、心血管EHE各1例;15例为单发病灶,8例见多发（3~36个）病灶。平扫T1WI中,20例病灶呈低信号、2例呈等信号、1例呈混杂信号;T2WI中,18例呈混杂信号、3例呈高信号、2例呈等信号。22例接受弥散加权成像检查,其中20例病灶呈高信号、2例呈等信号。21例接受增强扫描,12例病灶明显不均匀强化、9例轻度不均匀强化。结论 EHE的MRI表现具有一定特征性,结合临床有助于诊断。     

黏液性脂肪肉瘤的CT、MRI表现

目的 探讨黏液性脂肪肉瘤的CT、MRI表现特征。 方法 回顾性分析经手术病理证实的24例黏液性脂肪肉瘤的CT、MRI表现特点。18例术前接受CT平扫,其中9例同时接受增强扫描;6例接受MR平扫,其中5例同时接受增强检查。 结果 24例黏液性脂肪肉瘤均表现为单发结节或肿块;发生于下肢(n=12)尤其大腿(n=9)最为多见,其次是腹膜后(n=7);发生于四肢的14例患者中,病变位于肌间隙10例(n=10),肌肉内2例(n=2),皮下脂肪层内2例(n=2);15例肿瘤形态规则,边界尚清,9例形态不规则,边界不光整,可见分叶等征象;病灶最大径2.0~38.0 cm,平均(12.5±8.0)cm。18例CT平扫CT值11.0~30.0 HU,平均(19.4±6.8)HU;6例MR平扫T1WI病变与肌肉相比以等或稍低信号为主,2例内见云絮状高信号;4例T2WI病变与皮下脂肪相比以明显高信号为主,内有稍高信号区和(或)线样低信号分隔,2例呈均匀显著高信号;14例CT和MR增强后病变均表现为明显不均匀强化;CT强化最显著区CT值35.0~112.0 HU,平均(62.7±27.0)HU。 结论 黏液性脂肪肉瘤的CT、MRI表现有一定特征,CT平扫多为囊样低密度影,MRI以T1WI低信号、T2WI显著高信号为主,T2WI可伴稍高信号区和(或)线样低信号分隔,增强后多呈显著不均匀强化。     

肾上腺神经鞘瘤的CT和MR表现

目的 探讨肾上腺神经鞘瘤的CT和MR表现。方法 回顾性分析12例经手术病理证实的肾上腺神经鞘瘤的临床及影像学资料,所有患者接受CT平扫及增强扫描,4例接受MR平扫及增强扫描。结果 12例肾上腺神经鞘瘤均单发,其中左侧8例,右侧4例,肿瘤体积1.75 cm×1.64 cm×2.91 cm~12.56 cm×9.63 cm×25.26 cm,CT平扫8例为均匀等密度或略低密度,4例密度不均,内有坏死、囊变,其中1例伴少许钙化,平均CT值15~40 HU,增强后呈轻至明显强化,实质部分强化均匀,囊性部分无强化。MR平扫示肿瘤在T1WI表现为等或低信号,T2WI为稍高信号,1例肿瘤信号均匀,增强扫描明显均匀强化;3例由于坏死、囊性变信号不均。结论 CT和MRI显示肾上腺区病变具有完整包膜、内部囊性变、出血、钙化及渐进式强化等为肾上腺神经鞘瘤主要影像学特征,可提示肾上腺神经鞘瘤诊断、并为临床诊治提供重要信息。     

长骨良性纤维组织细胞瘤的影像表现

目的 分析骨良性纤维组织细胞瘤(BFH)的影像表现。方法 经手术病理证实的9例BFH患者均接受X线检查,且其中4例接受MR平扫及增强扫描,4例接受CT检查。结果 9例BFH均为位于下肢的单发病灶,其中胫骨5例,股骨3例,腓骨1例。X线片均表现为偏心溶骨性骨破坏区,边界清晰,骨皮质变薄,可有不同程度的硬化缘;CT平扫显示骨质破坏区为与肌肉密度相仿的软组织密度影,2例病灶位于膨胀的骨壳内,2例位于胫骨的病灶穿破骨皮质,未见软组织肿块;所有病灶均未见骨膜反应。病灶T1WI呈等低信号,T2WI呈混杂高信号,增强MRI呈均匀或不均匀中度或明显强化。结论 长骨BFH的影像表现可为临床诊断提供依据。     

CT和MRI诊断侵袭性血管黏液瘤

目的 探讨侵袭性血管黏液瘤(AAM)的CT和MRI表现。 方法 回顾性分析11例接受盆腔CT或MR检查并经手术、病理证实的AAM患者,男1例,女10例,中位年龄36岁,分析AAM的临床特点及影像学表现。 结果 7例会阴部或臀部皮下肿块穿越盆膈延伸至盆腔,2例位于外阴,1例位于会阴部向上延伸至左下腹皮下,1例位于腹膜后。7例接受CT平扫,与肌肉密度相比,其中5例呈等密度,1例呈等低混杂密度,1例囊实混合;5例接受增强CT扫描,2例呈缓慢强化,1例呈絮状及分隔样强化,1例不均匀强化合并未强化囊变区,1例未见强化,其中2例出现漩涡样或分层状强化。8例接受MR检查,与肌肉信号相比,病灶T2WI高信号5例,稍高信号3例(1例合并显著高信号囊变区),5例出现典型漩涡状或分层样改变;T1WI低信号2例,稍低信号4例,等信号2例,其中3例病灶内部信号不均匀,2例内见条形或斑片样T1WI稍高信号。4例接受增强MR扫描,呈不均匀强化,1例见未强化囊变区。 结论 AAM表现为患者单侧会阴区逐渐增大的软组织肿块穿越盆膈进入盆腔,MR T2WI表现为高信号及漩涡样改变,MR及CT增强扫描缓慢强化为AAM的特点。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

儿童中枢神经系统感染脑脊液主要病原菌的构成及耐药性的监测

目的探讨儿童中枢神经系统感染脑脊液病原菌的构成及耐药性。方法全自动细菌鉴定仪VITEK32进行细菌鉴定和药敏实验并结合K B药敏实验法,根据美国临床和实验室标准协会(CLSI)标准进行结果判读。结果住院患儿中枢神经系统感染脑脊液标本1 990份共分离病原菌181株,检出阳性率9.1%（181/1 990）。细菌检出率95.0%（172/181）,真菌检出率5.0%（9/181）,其中肺炎链球菌19.3%（35/181）,表皮葡萄球菌18.8%（34/181）,大肠埃希菌17.1%（31/181）。3种主要细菌的分离率较高,主要集中分布在1岁以内患儿。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶（ESBLs）检出率较高,分别为41.9%（13/31）和50.0%（3/6）。主要的革兰阴性细菌大肠埃希菌和肺炎克雷伯菌对厄它培南和亚胺培南耐药率为0,未发现耐万古霉素的革兰阳性细菌。结论对中枢神经系统感染患儿脑脊液进行培养和药敏实验,根据药敏结果合理选用抗生素,对降低细菌的耐药和提高药物的敏感性,临床合理使用抗菌药物有指导作用。     

吗啡、氯胺酮联合用于术后镇痛临床观察

目的 :比较吗啡、氯胺酮联合与吗啡单独使用用于术后镇痛的临床效果。方法 :30例ASAⅠ～Ⅱ的腹部手术全麻病人随机分为两组 ,术后使用吗啡静脉自控镇痛并分别加氯胺酮静脉输注 (氯胺酮组 )和生理盐水静脉输注(生理盐水组 )。观察两组的视觉模拟评分 (VAS) ,吗啡消耗量和发生的